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�; " . <br /> CITY OF ORONO <br /> . BUILDING PERMIT APPLICATION <br /> , FOR NEW STRUCTURES OR ADDITIONS <br /> �O�O MailingAddress: . Permitnumber: ��� �114'I� <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 9' �/ <br /> StreetAddress:' Received by: <br /> y � 2750 Keliey Parkway Plan review fee: � 9 <br /> Ft,� R�,�' Orono, MN 55356 �0 <br /> k�S�Q Total Fee: � y�0 �g <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATIO • �, <br /> Job Site Address: I� 1 ',-( r,r����j,. �.�� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and Crty Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates su�cient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: , f <br /> N a me: ��c:.,.�. �E:�wsc.�-� H c�-rrL:,S, J_v� <br /> State License# �, V?� �*�� Expiration Date: <br /> Phone: (cell) �(,�3 --�4•�—"T 3c I (office) ��,,?,— (�.7q �— 4'�,�� <br /> Mailing Address: 4'1�c: �.,� `i?,.c�, I q Cit : +'��L•..e,. ZIP: ����,r� "'1 <br /> Contact Person: ��N�„� Applicant is: ractor� / Homeowner (Circle One) <br /> Email and/or Fax: ��, „�,��Y, C=�_ c�G...�..�1h�� i;�e��..a _ C�.•�. 7(:y=� —�-7ar^ 4�s�7..\ <br /> PROPERTY OWNER INFORMA�ION: <br /> Name: F�-`�rn.,.� � ��-a.c,,�; � �.,�5 <br /> Phone (day): � <br /> Address: City: ZIP: <br /> Email and/or Fax <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of pro�ect: <br /> 1. Type of Project 2. Proposed Use 3.Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> '�ew Construction �ingle Family with �esidence <br /> Addition attached garage Garage/Accessory Bldg. �'ublic Sewer <br /> ❑ Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Warehouse <br /> ❑ Public ❑ Storage �Public Water <br /> "*Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review 8�permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Othef: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.min nehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 34�� C�G G� <br /> 4 <br />